Abstract
Community health volunteers (CHVs) play an integral role in primary healthcare. Several countries rely on CHV programs as a major element in improving access to care and attaining universal health coverage. However, their performance has been heterogeneous and at times context-specific, and influenced by multiple factors. We describe the socio-demographic and workplace characteristics affecting CHVs' performance in a public health program in rural western Uganda. This was a cross-sectional study based on routine program data of CHVs serving the catchment of Bwindi Community Hospital, Kanungu District, South Western Uganda, in 2014 and 2015. Information was collected on individual socio-demographic and workplace characteristics of the CHVs. To assess their work output, we defined study-specific targets in terms of attendance at monthly CHVs' meetings with community health nurses, households followed-up and reported, children screened for malnutrition, immunization coverage, and health facility deliveries. Frequencies and proportions are reported for characteristics and outputs and odds ratios for study-specific factors associated with overall performance. Of the 508 CHVs, 65% were women, 48% were aged 35 years and below, and 37% took care of more than the recommended 20-30 households. Seventy-eight percent of the CHVs had ≥80% of pregnant women under their care delivering in health units, 71% had ≥95% of the children on schedule for routine immunization, while 27% screened ≥75% of the children under 5 years for malnutrition. More refresher trainings was associated with better overall performance [adjusted odds ratio (aOR): 12.2, 95% confidence interval (CI): 1.6-93.6, P = 0.02] while overseeing more than the recommended 20-30 households reduced overall performance (aOR: 0.6, 95% CI: 0.4-0.9, P = 0.02). Being in-charge of more than the recommended households was associated with reduced performance of CHVs, while more refresher trainings were associated with improved performance. If the CHVs are to remain a strategic pillar in universal health coverage, it is imperative to address those factors known to impact on their performance.
Highlights
Lay community health workers, often interchangeably referred to as community health volunteers (CHVs), are increasingly recognized as an integral component of the health workforce, especially in low- and middle-income countries (LMICs) [1]
There were 508 CHVs working in the catchment area of Bwindi Community Hospital
Carried out in the setting of routine programmatic conditions, this study adds to the body of knowledge in the area where CHVs are deemed essential in the attainment of universal health coverage [2, 23]
Summary
Often interchangeably referred to as community health volunteers (CHVs), are increasingly recognized as an integral component of the health workforce, especially in low- and middle-income countries (LMICs) [1]. Several LMICs invested in CHV programs as a major element of improving access to care and achieving the millennium development goals. CHVs are expected to carry out general tasks in all primary health-care core areas. These include home visits, mobilization of communities to utilize health services, community information management, health promotion and education, management of common illnesses, and follow-up of pregnant women and newborns and follow-up of discharged patients and those on long-term treatment [16]. Some of the factors described to improve their performance include support from the community and health facilities, adequate work resources, regular feedback, and supervision [3, 6, 11, 13, 17, 18]. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented [17,18,19]
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